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Wichlas F, Haybäck G, Hofmann V, Deluca A, Traweger A, Deininger C. Advancing fracture management: the role of minimally invasive osteosynthesis in orthopedic trauma care. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02634-4. [PMID: 39167216 DOI: 10.1007/s00068-024-02634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Minimally Invasive Osteosynthesis (MIO) developed to be a key technique in orthopedic trauma surgery, offering a less invasive alternative for managing fractures in various anatomical regions. However, standardized guidelines for its application are lacking. This study aims to establish comprehensive principles for MIO to guide surgeons in treating different types of fractures and its locations. METHODS A retrospective analysis including 57 fractures in 53 patients was conducted. All patients were treated with MIO. Study range - March 2017 to January 2022 at a Level-I trauma university hospital. The analysis covered various fracture types, focusing on surgical approaches, reduction techniques, plate insertion methods, and its outcomes. The efficacy and safety of MIO was evaluated by analyzing complications, fracture healing time, and necessary revision surgeries. RESULTS MIO is a versatile and effective fracture treatment that minimized soft tissue damage and ensured stable osteosynthetic results. Articular fractures typically used a "one way up" plate insertion technique, while non-articular fractures applied an "inside-up-and-down" approach. Low complication rates confirmed the safety and efficiency of MIO. CONCLUSION This research established generalized principles for MIO, offering a systematic approach that can be applied for various fracture types and its locations, by overall enhancing the surgical efficiency as well as patient recovery, without compromising outcomes. LEVEL OF EVIDENCE This study is classified as Level III evidence according to "The Oxford 2011 Levels of Evidence".
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Affiliation(s)
- Florian Wichlas
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria.
- No Limit Surgery, Ernest-Thun-Strasse 6, Salzburg, 5020, Austria.
| | - Gerwin Haybäck
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Valeska Hofmann
- No Limit Surgery, Ernest-Thun-Strasse 6, Salzburg, 5020, Austria
- Department of Orthopaedic and Trauma Surgery, Karl-Olga-Krankenhaus, Hackstrasse 61, Stuttgart, 70190, Germany
| | - Amelie Deluca
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University, Salzburg, Austria
| | - Christian Deininger
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria.
- No Limit Surgery, Ernest-Thun-Strasse 6, Salzburg, 5020, Austria.
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University, Salzburg, Austria.
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Zirngibl M, Weitz M, Luithle T, Tönshoff B, Nadalin S, Buder K. Current management of symptomatic vesicoureteral reflux in pediatric kidney transplantation-A European survey among surgical transplant professionals. Pediatr Transplant 2024; 28:e14621. [PMID: 37830523 DOI: 10.1111/petr.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Vesicoureteral reflux (VUR) is common in children and adolescents undergoing kidney transplantation (KTx) and may adversely affect allograft kidney function. METHODS To explore the current management of symptomatic native and allograft VUR in pediatric KTx recipients, an online survey was distributed to European surgical transplant professionals. RESULTS Surgeons from 40 pediatric KTx centers in 18 countries participated in this survey. Symptomatic native kidney VUR was treated before or during KTx by 68% of the centers (all/selected patients: 33%/67%; before/during KTx: 89%/11%), with a preference for endoscopic treatment (59%). At KTx, 90% favored an anti-reflux ureteral reimplantation procedure (extravesical/transvesical approach: 92%/8%; preferred extravesical technique: Lich-Gregoir [85%]). Management strategies for symptomatic allograft VUR included surgical repair (90%), continuous antibiotic prophylaxis (51%), bladder training (49%), or noninterventional surveillance (21%). Redo ureteral implantation and endoscopic intervention for allograft VUR were equally reported (51%/49%). CONCLUSIONS This survey shows uniformity in some surgical aspects of the pediatric KTx procedure. However, with regard to VUR, there is a significant variation in practice patterns that need to be addressed by future well-designed and prospective studies. In this way, more robust data could be translated into consensus guidelines for a more standardized and evidence-based management of this common condition in pediatric KTx.
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Affiliation(s)
- Matthias Zirngibl
- Department of General Pediatrics and Hematology/Oncology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Marcus Weitz
- Department of General Pediatrics and Hematology/Oncology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Luithle
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Kathrin Buder
- Department of General Pediatrics and Hematology/Oncology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany
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Jalaeian H, Field DH, Cohen EI. Transplant Renal Interventions. Tech Vasc Interv Radiol 2023; 26:100925. [PMID: 38123287 DOI: 10.1016/j.tvir.2023.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Renal transplantation is the most commonly performed solid-organ allograft surgery; in 2021, 25487 kidneys were transplanted in the United States, and nearly 42,000 adult patients were listed for transplant. As the treatment of choice for patients with end-stage renal disease, transplantation is performed at more than 250 centers. Despite a high rate of success, renal transplantation is not without complication, and the interventional radiologist plays a crucial role in the management of the postoperative patient. Knowledge of postsurgical anatomy, imaging findings, and technical challenges unique to these patients is important for the safe and effective treatment of transplant-related conditions. We offer a guide to the most common interventions in the renal transplant population, including biopsy, vascular interventions, and the management of urinary obstruction.
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Affiliation(s)
- Hamed Jalaeian
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL.
| | - David H Field
- Division of Interventional Radiology, MedStar Georgetown University Hospital, Washington, DC
| | - Emil I Cohen
- Division of Interventional Radiology, MedStar Georgetown University Hospital, Washington, DC
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Giulioni C, Palantrani V, De Stefano V, Cicconofri A, Antezza A, Beltrami M, Milanese G, Ranghino A, Gauhar V, Castellani D, Galosi AB. Current Evidence on Surgical Management for Benign Prostatic Hyperplasia in Renal Transplant Recipients: A Systematic Review. J Endourol 2023; 37:1129-1138. [PMID: 37597196 DOI: 10.1089/end.2023.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Background: Patients who have undergone renal transplant may have a concomitant benign prostatic hyperplasia (BPH), a condition that can potentially hinder the recovery of the renal graft and necessitate surgical intervention. However, endoscopic treatment of BPH should be performed carefully because of the associated perioperative risks. We aimed to systematically assess the factors affecting surgical indications and perioperative outcomes of BPH surgical treatment in renal transplantation (RT) recipients. Methods: A systematic literature search was performed on January 28, 2023, using Scopus, PubMed, and EMBASE with no date limit. Preclinical and animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Results: Eighteen articles were accepted and included. Clinical BPH has a high incidence rate after RT, particularly in elderly men. Secondary events associated with BPH, such as acute urinary retention and urinary tract infections, can lead to a gradual decline of renal graft function and patient survival. BPH procedure can prevent these events and guarantee improvements in serum creatinine levels, voiding parameters, and lower urinary tract symptoms. When the urine culture is negative, the endoscopic procedure of the prostate may be performed within 1 month of the initial procedure, particularly in older patients, more prone to develop voiding dysfunction. Alternatively, a transurethral incision of the prostate may be recommended for patients with smaller prostates who wish to preserve ejaculatory function. Data on comparative BPH surgical procedures are lacking. Conclusions: BPH procedure should be offered in RT recipients who develop bladder outlet obstruction owing to BPH. Endoscopic treatment should be performed after a few weeks from RT to avoid further graft deterioration.
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Affiliation(s)
- Carlo Giulioni
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Vanessa Palantrani
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Virgilio De Stefano
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Cicconofri
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Angelo Antezza
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Mattia Beltrami
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Milanese
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Ranghino
- Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Benedetto Galosi
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
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Zhang J, Xue W, Tian P, Zheng J, Ding C, Li Y, Wang Y, Ding X, Lv Y. Effect of ureteral stricture in transplant kidney and choice of treatment on long-term graft survival. Int Urol Nephrol 2023; 55:2193-2203. [PMID: 37308613 PMCID: PMC10406706 DOI: 10.1007/s11255-023-03669-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND To explore the risk factors of ureteral stricture in transplant kidney and the clinical effects of different treatment methods. METHODS The 62 patients with transplant kidney ureteral stenosis as the experimental group, and another group of recipients from the same donor as the control group (n = 59 cases). The risk factors for ureteral stricture and the survival rate of transplant kidney were analyzed and compared. The 62 patients were divided into open operation, luminal operation, and magnetic compression anastomosis (MCA) operation group. The effect of the operation and the survival rate of transplant kidney among the three groups were compared. RESULTS In our study, we found that the above differences were statistically significant in clinical data such as gender, multiple donor renal arteries, history of infection, and delayed graft function (DGF) between the two groups (P < 0.05). Urinary tract infection and DGF history were the independent risk factors for the development of ureteral stricture. The open operation had the best treatment effect and the survival rate of the transplant kidney, followed by the MCA, the stricture recurrence rate in the luminal operation was the highest. CONCLUSION The ureteral stricture has a negative correlation with the long-term survival rate of the transplant kidney, the curative rate and long-term effect of open surgery are the best, stricture recurrence rate of luminal surgery is high, and it may require multiple operations in the future, the MCA is a new breakthrough and innovation in the treatment of ureteral stricture.
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Affiliation(s)
- Jiangwei Zhang
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Wujun Xue
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Puxun Tian
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jin Zheng
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chenguang Ding
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yang Li
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ying Wang
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xiaoming Ding
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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Territo A, Bravo-Balado A, Andras I, Campi R, Pecoraro A, Hevia V, Prudhomme T, Baboudjian M, Gallioli A, Verri P, Charbonnier M, Boissier R, Breda A. Effectiveness of endourological management of ureteral stenosis in kidney transplant patients: EAU-YAU kidney transplantation working group collaboration. World J Urol 2023; 41:1951-1957. [PMID: 37340277 PMCID: PMC10352153 DOI: 10.1007/s00345-023-04455-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/22/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Ureteral stenosis (US) in kidney transplant (KT) recipients is associated with poorer long-term graft survival. Surgical repair is the standard of care, and endoscopic treatment represents an alternative for stenosis < 3 cm. We aimed to determine the effectiveness and safety of endourological management of US in KT patients and predictors of failure. METHODS A retrospective multicenter study was conducted in four European referral centers, including all KT patients with US managed endoscopically between 2009 and 2021. Clinical success was defined as the absence of upper urinary tract catheterization, surgical repair or transplantectomy during follow-up. RESULTS A total of 44 patients were included. The median time to US onset was 3.5 months (IQR 1.9-10.8), the median length of stricture was 10 mm (IQR 7-20). Management of US involved balloon dilation and laser incision in 34 (79.1%) and 6 (13.9%) cases, respectively, while 2 (4.7%) received both. Clavien-Dindo complications were infrequent (10%); only one Clavien ≥ III complication was reported. Clinical success was 61% at last follow-up visit (median = 44.6 months). In the bivariate analysis, duckbill-shaped stenosis (vs. flat/concave) was associated with treatment success (RR = 0.39, p = 0.04, 95% CI 0.12-0.76), while late-onset stenosis (> 3 months post KT) with treatment failure (RR = 2.00, p = 0.02, 95% CI 1.01-3.95). CONCLUSIONS Considering the acceptable long-term results and the safety of these procedures, we believe that the endoscopic treatment should be offered as a first-line therapy for selected KT patients with US. Those with a short and duckbill-shaped stenosis diagnosed within 3 months of KT seem to be the best candidates.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Alejandra Bravo-Balado
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain.
| | - Iulia Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
| | - Riccardo Campi
- Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urologic Robotic, Minimally-Invasive Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy
| | - Vital Hevia
- Hospital Universitario Ramón y Cajal. Alcalá University. Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - Michael Baboudjian
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
| | - Mathieu Charbonnier
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, APHM, CHU de La Conception Hospital, 146, Boulevard Baille, 13005, Marseille, France
| | - Alberto Breda
- Department of Urology, Fundació Puigvert and Autonomous University of Barcelona, Carrer de Cartagena 340, Fundació Puigvert, 08025, Barcelona, Spain
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Leão CS, Foinquinos RA, Leao ALDES, Capela ICKO, Mello MJG. Ultrashort anisoperistaltic end-to-side ureteroureterostomy in renal transplantation. Rev Col Bras Cir 2022; 49:e20223365. [PMID: 36515332 PMCID: PMC10578784 DOI: 10.1590/0100-6991e-20223365-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022] Open
Abstract
The improvement of surgical techniques in kidney transplantation aims to reduce the incidence of post-transplant complications, contributing to the reduction of hospital stay, related costs, morbidity and mortality, in addition to improving the quality of life of patients. The choice of the best technique is influenced by several factors and the most common technique for urinary tract reconstruction in transplants is performed with implantation of the ureter of the graft in the caudal position, with the anastomosis performed in the bladder. However, the kidney pole can be inverted and the graft ureter anastomosis can be performed directly on the recipient's ureter, facilitating venous and ureteral anastomoses and reducing urological complications.
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Affiliation(s)
- Cristiano Souza Leão
- - Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Clínica Cirúrgica - Recife - PE - Brasil
- - Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Unidade Geral de Transplantes - Recife - PE - Brasil
- - Faculdade Pernambucana de Saúde - FPS - Recife - PE - Brasil
| | - Rafael Azevedo Foinquinos
- - Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Unidade Geral de Transplantes - Recife - PE - Brasil
- - Faculdade de Medicina de Olinda - FMO - Recife - PE - Brasil
| | | | | | - Maria Julia Gonçalves Mello
- - Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Departamento de Pesquisa e Pós Graduação - Recife - PE - Brasil
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LEÃO CRISTIANOSOUZA, FOINQUINOS RAFAELAZEVEDO, LEAO ANALUIZADESOUZA, CAPELA ILANCUBITSKYRILLOSOLIVEIRA, MELLO MARIAJULIAGONÇALVES. Anastomose uretero-ureteral término-lateral anisoperistáltica ultracurta no transplante renal. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RESUMO O aprimoramento das técnicas cirúrgicas no transplante renal tem o objetivo de reduzir a incidência de complicações pós-transplante, contribuindo com a redução do tempo de internamento hospitalar, os custos relacionados, a morbidade e a mortalidade, além de melhorar a qualidade de vida dos pacientes. A escolha da melhor técnica é influenciada por diversos fatores e a técnica mais comum de reconstrução do trato urinário nos transplantes é a realizada com implante do ureter do enxerto na posição caudal, com a anastomose feita na bexiga. No entanto, pode-se inverter o polo do rim, posicionando o polo inferior cranialmente e realizar a anastomose do ureter do enxerto diretamente no ureter do receptor, facilitando a anastomose ureteral e diminuindo as complicações urológicas.
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Affiliation(s)
- CRISTIANO SOUZA LEÃO
- Instituto de Medicina Integral Prof. Fernando Figueira, Brazil; Instituto de Medicina Integral Prof. Fernando Figueira, Brazil; Faculdade Pernambucana de Saúde, Brazil
| | - RAFAEL AZEVEDO FOINQUINOS
- Instituto de Medicina Integral Prof. Fernando Figueira, Brazil; Faculdade de Medicina de Olinda, Brasil
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